Keterangan
Managing pericardial effusion, a condition characterized by the accumulation of fluid around the heart within the pericardial sac, is a multi-faceted approach that aims to alleviate symptoms, identify the underlying cause, and prevent complications. The initial goal is to provide relief from symptoms such as chest pain, shortness of breath, and palpitations. This may involve pain management and measures to reduce fluid accumulation. Comprehensive diagnostic tests, including echocardiography and imaging, help determine the cause, size, and severity of the effusion. Pericardial effusion can be secondary to various conditions, such as infections, inflammatory diseases, or malignancies. Identifying and treating the underlying cause is crucial.
If the effusion is small and not causing significant symptoms or compromising cardiac function, a watch-and-wait approach may be employed. Nonsteroidal anti-inflammatory drugs (NSAIDs) or colchicine can be used to reduce inflammation. For patients with recurrent effusions, other interventions, such as pericardial sclerosis or pericardiectomy, may be considered to prevent fluid accumulation.
Ringkasan
- The pericardium is a fibroserous sac surrounding the heart, composed of the outer fibrous pericardium and the inner serous pericardium (parietal and visceral layers). The visceral layer is also known as the epicardium and is part of the heart wall. The pericardial cavity, between the visceral and parietal layers, contains 15-35 ml of fluid.
- The pericardium minimizes friction during heart activity, maintains cardiac position in the mediastinum, acts as a barrier, and contains mechanoreceptors that influence heart rate and blood pressure. Pericardial pressure decreases during inspiration and increases during expiration, resulting in a slight decrease in aortic pressure during inspiration. Jugular Venous Pressure (JVP) reflects central venous pressure and features A, C, and V waves, along with X and Y descents, corresponding to atrial contraction, tricuspid valve bulging, atrial filling, and atrial emptying, respectively.
- Pericardial effusion occurs when fluid accumulation increases due to production or decreased reabsorption. Rapid fluid accumulation leads to a significant increase in intrapericardial pressure. Clinical features include shortness of breath, chest discomfort, and lower extremity swelling. Diagnosis is confirmed via echocardiography, with treatment options including pericardiocentesis, pericardial window, and drainage.
- Pericarditis involves inflammation of the pericardium, diagnosed by pathological demonstration of inflammation, scarring, or thickening. Etiologies include idiopathic, infectious, autoimmune, post-operative, malignant, or metabolic causes. Clinical features of constrictive pericarditis include "egg in a cup" appearance on X-ray, square root sign on ECG, rapid Y descent in JVP, and a pericardial knock.
- Kussmaul's sign is an inspiratory increase in JVP. Pulsus paradoxus is an inspiratory decrease in systolic blood pressure exceeding 10 mmHg. Interventricular dependence occurs due to septal bounce during inspiration in pericardial effusion, reducing left ventricular volume and cardiac output. Treatment includes medical management (corticosteroids) and pericardectomy (partial, total, or radical).
- Partial pericardectomy requires freeing the left ventricular outflow tract before the inflow tract to avoid pulmonary edema. A "caged bird phenomenon" occurs when epicardial fibrosis limits cardiac function even after pericardial release. A case scenario illustrates the diagnosis and management of constrictive pericarditis, highlighting pericardial knock, echocardiography, and treatment options.
Contoh Sertifikat
Tentang Pembicara
Dr. Swati Pathak
Professor & HOD Pediatrics Nalanda Medical College, Patna
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